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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sipov.org/ehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Vow At 3►aIAg W)Wdms ns <br /> Facility address: USTI' - <br /> ✓3 `� ' C/ 1 -P educt �7 p ' - C1 I <br /> Facility Contact: Title: VPhone: <br /> Qryt tuonng anet: Piping system: U Overfill prevention: <br /> 1✓t^"La 'M"L ressunzed ❑Suction ❑Gravity ❑Mechanical Audible/visual <br /> Inspection type: Violations: <br /> Routine [Wonitaring Certification ❑Installation ❑Other: ❑MI-RDetect 2-RPrev ❑M-3 Both <br /> # Code Section <br /> VIOLATIONS) HSC=California Health&Safety Code;CCR=California Code of Regulations V R V=Violation; RV=Repeat Violation V <br /> I HSC 25284 Permit to operate <br /> 2 CCR 2637 Seconds containment test performed <br /> 3 CCR 2711 b)& c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 6 Monitoring Program(Monitoring&Response Plan)is current and approved by the local agency. <br /> 6 CCR 2712 i Monitoring Ian is onsite. <br /> 7 CCR 2712 6 Maintenance&monitoring records Ml <br /> 8 CCR 2643 d Daily monitoring of suction piping(pre-January, I, 1984) <br /> 9 HSC 25292.1 UST system iso erated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present (M I) <br /> I t CCR 2630 d UST system monitoring equipment is properly located to detect a leak (M 1) <br /> 12 HSC 25291 6 UST system monitoring equipment isoperational (M2) <br /> 13 CCR 2636 I Continuous monitoring system for underground piping&UDC is present Ml <br /> 14 CCR 2631 a Primary containment is roduct tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 Line leak detector(s) are installed M 1 <br /> l8 CCR 2635(b)(1) Spill container M2 <br /> 19 CCR 2635(b)(2) Overfill prevention system M2 <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disposed of <br /> 22 1 CCR 2650 Recording/reportingo- authorized releases Ml) <br /> 23 CCR 2715 Desi nated O erato (a)Statement from UST owner; -e) )whly inspection; t)Employee training <br /> 24 CCR 2638 a Annual monitoring cerfification <br /> 25 CCR 2638 a) Annual line leak detector test Ml) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test M1) <br /> 28 CCR 2661 Repair rtank/piping has had tightness test (M2) <br /> 29 CCR 2643 a Biennial tightness test of gravity piping re-Janus 1, 1984) <br /> 30 CCR 2643 d) Triennial line test for conventional suction piping( re-Janus 1, 1984) (MI) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 a Permit to alter monitoring system <br /> 34 HSC 25298 b) Permit to temporarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298 a) Illegal abandonment of UST system <br /> 38 Other: <br /> EHI INS E R: PHONE: UIC <br /> Septic system <br /> Serves>_20 people/day <br /> RE 'IVED BY: TITLE: -Receives other than sanitary waste <br /> Other disposal methods: <br /> -Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />